Prolonged shedding of severe acute respiratory syndrome coronavirus 2 in patients with COVID-19

• Published in: Emerging microbes & infections Vol. 9; no. 1; pp. 2571 - 2577
• Main Authors: Li, Qian, Zheng, Xiao-Shuang, Shen, Xu-Rui, Si, Hao-Rui, Wang, Xi, Wang, Qi, Li, Bei, Zhang, Wei, Zhu, Yan, Jiang, Ren-Di, Zhao, Kai, Wang, Hui, Shi, Zheng-Li, Zhang, Hui-Lan, Du, Rong-Hui, Zhou, Peng
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.01.2020; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Adult; Aged; Antibodies, Neutralizing; Antibodies, Viral - blood; Carrier State; Coronaviruses; COVID-19; COVID-19 - virology; Female; Genome, Viral; Humans; Immunoglobulin G - blood; Immunoglobulin M - blood; long-term carrier; Male; Middle Aged; prolonged shedding; RNA, Viral - isolation & purification; SARS-CoV-2; SARS-CoV-2 - physiology; Severe acute respiratory syndrome coronavirus 2; Sputum - virology; transmission risk; Virus Shedding; COVID-19; prolonged shedding; transmission risk; SARS-CoV-2; long-term carrier
• ISSN: 2222-1751; 2222-1751
• DOI: 10.1080/22221751.2020.1852058

Following acute infection, individuals COVID-19 may still shed SARS-CoV-2 RNA. However, limited information is available regarding the active shedding period or whether infectious virus is also shed. Here, we monitored the clinical characteristics and virological features of 38 patients with COVID-19 (long-term carriers) who recovered from the acute disease, but still shed viral RNA for over 3 months. The median carrying history of the long-term carriers was 92 days after the first admission, and the longest carrying history was 118 days. Negative-positive viral RNA-shedding fluctuations were observed. Long-term carriers were mostly elderly people with a history of mild infection. Infectious SARS-CoV-2 was isolated from the sputum, where high level viral RNA was found. All nine full-length genomes of samples obtained in March-April 2020 matched early viral clades circulating in January-February 2020, suggesting that these patients persistently carried SARS-CoV-2 and were not re-infected. IgM and IgG antibodies and neutralizing-antibody profiles were similar between long-term carriers and recovered patients with similar disease courses. In summary, although patients with COVID-19 generated neutralizing antibodies, they may still shed infectious SARS-CoV-2 for over 3 months. These data imply that patients should be monitored after discharge to control future outbreaks.